肝周膜隔绝联合三氧化二砷肝区域双灌注栓塞治疗兔VX2肝癌的研究

发布时间：2018-01-26 12:44

本文关键词： 三氧化二砷 VX2兔肝癌血供阻断　出处：《福建医科大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的:观察肝周膜隔绝联合三氧化二砷肝区域双灌注栓塞治疗兔VX2肝癌的疗效。方法:新西兰大白兔32只,开腹接种法建立VX2肝癌模型。造模成功的30只VX2肝癌兔按随机数字表法分为A、B、C、D四组。A组(6只):对照组/静脉注射组,不开腹置管,只经耳缘静脉注射三氧化二砷;B组(8只):TAE联合三氧化二砷区域灌注组;C组(8只):TAVE联合三氧化二砷区域灌注组;D组(8只):TAVE联合肝周防粘连隔离膜包裹联合三氧化二砷区域灌注组。造模后2周,手术开腹置管。术前1d和术后3、7、14d,抽取四组VX2肝癌兔外周静脉血检测ALT、AST。术前1d和术后第14d行胸、腹部CT扫描,计算肿瘤体积及观察肺部转移情况;比较各组实验兔术后生存时间。各观察指标结果以均数±标准差来表示。各时间点各组之间的比较采用单因素方差分析,多组间两两比较采用LSD法,各组变化趋势之间的比较采用重复测量资料的方差分析。各组间肺转移比较采用Pearson Chi-square卡方检验。Kaplan-Meier法进行生存分析,log-rank检验进行组间比较。结果:1.造模后13d(术前1d)行CT扫描及造模后2周手术开腹,四组肿瘤均接种成功,成功率100%,肿瘤表面呈灰白色。2.ALT、AST变化情况:术前1d,四组VX2肝癌兔ALT、AST水平差异无统计学意义(P0.05);术后第3d,B、C、D组ALT、AST水平较A组明显升高(P0.05),其中,C、D组升高最为明显;术后第7d,ALT、AST水平在A组有所上升,B、C、D组开始下降,但仍高于A组(P0.05),同时C组ALT、AST水平高于B组(P0.05),D组ALT水平高于B组(P0.05);术后第14d,A组ALT、AST水平仍继续升高,B、C、D组ALT水平继续下降,AST水平有所升高,A组ALT、AST水平较B、C、D组均高(P0.05),同时C组AST水平高于B组(P0.05)。3.肿瘤体积变化:术前1d,四组VX2肝癌兔肿瘤体积差异无统计学意义(P0.05);术后第14d,四组肿瘤体积增大,B、C、D组较A组肿瘤体积小(P0.05),其中D组肿瘤体积最小。4.肺部转移情况:术前1d,四组VX2肝癌兔均未发现肺部转移;术后第14d,A组肺部转移率最高(P0.05),D组肺转移率较B、C组低(P0.05)。5.中位生存期:A组:21.17±1.60d;B组24.80±1.47d;C组27.00±1.41d;D组32.29±2.56d。B、C、D组生存时间较A组明显延长(P0.05),D组生存时间最长(P0.05)。结论:1.三氧化二砷通过外周静脉注射治疗VX2肝癌兔,虽然短期内对肝脏损伤较小,但随着治疗时间延长,将严重影响肝脏功能。并且此种全身化疗方法不能很好抑制肿瘤的生长和降低肿瘤转移率,VX2肝癌兔的生存期较短。2.三氧化二砷联合TAVE与联合TAE治疗VX2肝癌兔相比较,前者在短期内会加重肝脏损伤,但不增加VX2肝癌兔的死亡率。两种方法抑制肿瘤生长的能力和降低肿瘤转移率相当,但均优于全身化疗。三氧化二砷联合TAVE能更好的延长生存期。3.VX2肝癌兔采用TAVE联合肝周防粘连隔离膜包裹联合三氧化二砷区域灌注治疗,较其他治疗方法能更好的延长生存时间,是一种疗效较好的治疗肝癌的方法。
[Abstract]:Objective: to observe the efficacy of perihepatic membrane isolation combined with arsenic trioxide double perfusion embolization in the treatment of VX2 liver cancer in rabbits. Methods: 32 New Zealand white rabbits. The VX2 hepatoma model was established by abdominal inoculation. Thirty VX2 hepatoma rabbits were randomly divided into four groups: control group and intravenous injection group. Only arsenic trioxide was injected intravenously through the ear margin without abdominal catheterization. Group B (n = 8): combined with arsenic trioxide group (n = 8); Group C (n = 8): group C (n = 8) combined with arsenic trioxide group (n = 8); Group D (n = 8): 1 day before operation and 7 days after operation, 8 rats in group D were encapsulated with antiadhesion isolating membrane around the liver and infused with arsenic trioxide (as). 2 weeks after modeling, abdominal catheterization was performed, 1 day before operation and 7 days after operation. Peripheral venous blood was collected from four groups of VX2 liver cancer rabbits to detect alt AST.The chest and abdominal CT scans were performed 1 day before operation and 14 days after operation to calculate tumor volume and observe lung metastasis. The survival time of experimental rabbits in each group was compared. The results of each observation index were expressed as mean 卤standard deviation. At each time point, single factor analysis of variance was used to compare each group, and LSD method was used to compare the two groups. Analysis of variance of repeated measurements was used to compare the trend of lung metastasis among groups. Pearson was used to compare lung metastasis among groups. Chi-square chi-square test. Kaplan-Meier method for survival analysis. Log-rank test was compared among groups. Results 1. Ct scan was performed 13 days (1 day before operation) and operation was performed 2 weeks after modeling. All the four groups were successfully inoculated and the success rate was 100%. The changes of alt AST on tumor surface were gray. 2. The level of alt AST in VX2 liver cancer rabbits in the four groups had no significant difference at 1 day before operation (P 0.05). On the 3rd day after operation, the level of alt in group D was significantly higher than that in group A (P 0.05), especially in group D. On the 7th day after operation, the level of alt AST increased in group A and began to decrease in group D, but it was still higher than that in group A (P 0.05) and ALT in group C. The level of AST in group D was higher than that in group B (P 0.05) and the level of ALT in group D was higher than that in group B (P 0.05). The level of ALT in group A continued to decrease on the 14th day after operation. The level of AST in group A was higher than that in group B. The level of AST in group C was higher than that in group B (P 0.05). The change of tumor volume was 1 day before operation. There was no significant difference in tumor volume among the four groups of VX2 liver cancer rabbits (P 0.05). On the 14th day after operation, the tumor volume in group D was smaller than that in group A (P 0.05), and the tumor volume in group D was the smallest. 4. Lung metastasis: 1 day before operation. No lung metastasis was found in VX2 liver cancer rabbits in the four groups. On the 14th day after operation, the lung metastasis rate of group A was the highest and the lung metastasis rate of group D was lower than that of group B C. The median survival time of group A was 21.17 卤1.60 days. Group B 24.80 卤1.47 days; Group C 27.00 卤1.41d; The survival time of group D was significantly longer than that of group A (32.29 卤2.56 d.BP0.05). Conclusion: 1. Arsenic trioxide is injected into peripheral vein to treat VX2 liver cancer rabbits, although the liver damage is small in the short term, but with the prolongation of treatment time, the survival time of group D is longer than that of P0.050.Conclusion arsenic trioxide can be injected into peripheral vein to treat VX2 liver cancer rabbits. Liver function will be seriously affected. And this systemic chemotherapy method can not well inhibit tumor growth and reduce tumor metastasis rate. The survival time of VX2 liver cancer rabbits was shorter than that of VX2 liver cancer rabbits. Arsenic trioxide combined with TAVE combined with TAE could aggravate liver injury in a short period of time. But the death rate of VX2 liver cancer rabbits was not increased. The ability of both methods to inhibit tumor growth and reduce the rate of tumor metastasis were similar. Arsenic trioxide combined with TAVE could prolong the survival time. 3. VX2 hepatoma rabbits were treated with TAVE combined with antiadhesion isolation membrane and regional infusion of arsenic trioxide. Compared with other treatment methods, it can prolong the survival time better, and is a better therapeutic method for liver cancer.
【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R735.7

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